David Musoke

Makerere University · Department of Disease Control & Environmental Health

Background As many countries aim to eliminate malaria, use of comprehensive approaches targeting the mosquito vector and environment are needed. Integrated malaria prevention advocates the use of several malaria prevention measures holistically at households and in the community. The aim of this systematic review was to collate and summarize the im...

Background: Sub-Saharan Africa has the highest estimated death rate attributable to antimicrobial resistance (AMR), especially due to Extended-Spectrum Beta-Lactamase-producing Enterobacterales (ESBL-E). However, the dynamics of human colonisation in the community with ESBL-E are not well described. Inadequate water, sanitation and hygiene (WASH)...

A north-south higher education partnership between Nottingham Trent University, UK, and Makerere University School of Public Health, Uganda, has, over 10 years, facilitated health promotion research and practice through strengthening the primary health-care system in semi-rural communities in Uganda using a shared ownership approach. Through a blen...

Introduction: Redistribution of essential medicines and health supplies (EMHS) is a mechanism to address supply chain uncertainty by moving excess stock of health commodities from health facilities that are overstocked to health facilities with shortages, where it is most needed. It prevents the wastage of scarce resources and improves efficiency...

In their study on how Joint Health facility Inspections (JHI) were implemented in practice with a need to identify key facilitators or barriers for regulatory policy and practice, Tama et al found that innovative regulatory reforms markedly improved inspection scores among intervention health facilities albeit with challenges. Their article makes a...

Many countries across the world instituted lockdowns as a measure to prevent the spread of COVID-19. However, these lockdowns had consequences on health systems. This study explored effects of the COVID-19 lockdown measures on health and healthcare services in Uganda. The qualitative study employed focus group discussions (FGDs), household intervie...

Background The role of human, animal and environmental health workers is increasingly being recognized and linked to the emergence and transmission of antimicrobial resistance (AMR). Little has been done in low and middle-income countries despite the seriousness of this public health challenge. Our study explored the perspectives of health workers...

Background Cardiovascular disease (CVD) risk factors are increasing in many sub-Saharan African countries and disproportionately affecting communities in urban slums. Despite this, the contextual factors that influence CVD risk among slum communities have not been fully documented to guide interventions to prevent and control the disease. Objectiv...

Background An increase in mental health problems has been reported since the beginning of the COVID-19 pandemic. However, little is known about the prevalence of depressive and anxiety disorders, and how recent COVID-19 diagnosis may influence risk of these conditions especially in low-income settings. In this study, we assessed the association bet...

Background Adult substance use may be a significant predictor of sleeping problems, according to extant research. Children exposed to secondhand (SHS) also have a high likelihood of sleep problems. There is limited information on the relationships between exposure to psychoactive substances and subsequent sleep issues in adults and children, partic...

Despite increasing evidence of the challenges affecting Community Health Workers (CHWs) such as those related to training, supportive supervision and remuneration, there is a need to explore concerns and challenges from the perspective of CHWs themselves. This commentary highlights some of the contested and unexplored notions of challenges affectin...

Background Extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-PE) represents a significant global public health concern. Much as humans, animals and environments harbor ESBL-PE, its epidemiology in Uganda is still not well understood. This study explains the epidemiology of ESBL-PE using the one health approach in selected farming ho...

Background: Early Initiation of antenatal care (ANC) and at least four visits during pregnancy allow screening and support for a healthy lifestyle and self-care during pregnancy however, community-directed interventions to improve access to these services are rarely explored. Objective: To assess the effect of community health worker (CHW) invol...

Aim: We examined the maternal healthcare-seeking behaviour of peri-urban women with disabilities in Busiro South Health Sub District, Wakiso district, Uganda. Methods: This community-based cross-sectional study. Data were collected using semi-structured questionnaires and focus group discussions. Chi-square was used to test for differences, and log...

Introduction Redistribution of essential medicines and health supplies (EMHS) is a mechanism to address supply chain uncertainty by moving excess stock of health commodities from health facilities that are overstocked to health facilities with shortages where it is most needed. It prevents the wastage of scarce resources and improves efficiency wit...

Ecological sanitation (Ecosan) technology was introduced to improve sanitation through the reuse of excreta resources, particularly in developing countries. However, the adoption of Ecosan technology is low which makes its diffusion complex, especially in diverse spatial and socio-cultural contexts. This review of literature aimed to use the innova...

Background Globally, alcohol use significantly contributes to the disease burden. Alcohol consumption in Uganda is related to several health consequences among young people, including university students. Social media is commonly used by students to share academic information and create social networks. Among young people in high-income countries,...

Introduction Environmental health professionals (EHPs) in Uganda refer to Environmental Health Officers, Health Inspectors and Health Assistants who are all responsible for implementing interventions to prevent disease occurrences. These EHPs either work in the public or private sector in various capacities, and their practice is regulated by the M...

Background Low- and middle-income countries (LMICs) have high morbidity and mortality from drug-resistant infections, especially from enteric bacteria such as Escherichia coli. LMICs have varying infrastructure and services in the community to separate people from human and animal waste, creating risks for ESBL-Enterobacterales (ESBL-E) transmissio...

Background Antimicrobial resistance (AMR) represents an important threat to achieving the sustainable development goals in Sub-Saharan Africa (sSA). sSA is reported to have the highest estimated death rate attributable to AMR, with Extended-Spectrum Beta-Lactamase-producing Enterobacterales, such as Klebsiella pneumoniae and Escherichia coli , repr...

Background The utilization of “on-site excreta decomposition technology” known as “Ecological sanitation (Ecosan)” has a rational use of human excreta. It is a resource-oriented sanitation mostly feasible in areas with rocky soil and prone to agriculture. This technology was implemented in Rwanda for more than a decade. However, little is known abo...

Background Indoor air pollutants (IAP) such as particulate matter (PM) and carbon monoxide (CO) are a leading cause of acute respiratory symptoms, and long-term health impacts such as respiratory diseases, heart diseases and cancers. In Uganda, literature on the effects of IAP on respiratory outcomes in informal settlements is limited. This study i...

Adherence to mask wearing has the potential to reduce coronavirus disease 2019 acquisition risk. However, there is limited information about community mask wearing and its predictors among rural populations. This study aimed to assess the level of adherence to community mask wearing as a COVID-19 prevention measure, its barriers, and motivators amo...

Background Despite the availability of a highly effective vaccine, measles remains a substantial public health problem in many countries including Uganda. In this study, conducted between June–August 2020 following a local outbreak, we sought to explore the factors that could affect measles vaccination coverage in rural western Uganda. Methods We...

Photovoice methodology centralises the voices of marginalised populations within health systems using photography and critical dialogue to record, reflect and communicate community health issues. This paper presents findings from applying photovoice to explore and document the lived experiences of groups of marginalised populations in six low- and...

Background Globally, burn related deaths are disproportionately higher among children below 5 years of age compared to other age groups. Although rarely fatal, most burns in this group occur within homes specifically in kitchens. This study assessed the prevalence, risk factors and perceptions of caregivers regarding burns among children under 5 ye...

Background Private drug sellers play a critical role in treating children with malaria, pneumonia and diarrhea which remain the leading causes of mortality in children less than five years in many low-and middle-income countries. The onset of COVID-19 led to intermittent lockdowns resulting in curtailed movement of people including for access of he...

Globally, billions of people still lack access to safe water, including basic drinking water services, particularly in sub-Saharan Africa. We analyzed water quality for improved water sources and associated factors in Kibuku district, Eastern Uganda. The mixed-methods study employed included; water quality analysis, a questionnaire survey, and key...

Introduction There are several challenges associated with breast cancer detection in Uganda and other low-and-middle-income countries. One of the identified challenges is attributed to the health workers' gender, which facilitates gender disparities in access to breast cancer detection services. Although this challenge is well acknowledged in exist...

Background An essential means to control malaria is diagnosing suspected patients with a confirmatory test, treatment of malaria confirmed cases, and proper case registration (track). In 2011, the Ministry of Health launched a country-wide malaria Test, Treat and Track policy. We assessed implementation of the malaria Test, Treat and Track policy i...

In sub-Saharan Africa (sSA), there is high morbidity and mortality from severe bacterial infection and this is compounded by antimicrobial resistance, in particular, resistance to 3rd-generation cephalosporins. This resistance is typically mediated by extended-spectrum beta lactamases (ESBLs). To interrupt ESBL transmission it will be important to...

Background Significant progress in malaria prevention during the past two decades has prompted increasing global dialogue on malaria elimination. Recent reviews on malaria strategies have focused mainly on long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), with little emphasis on other prevention methods. This article is a s...

Background As the COVID-19 pandemic continues, there is an increasing reliance on community health workers (CHWs) to achieve its control especially in low, and middle-income countries (LMICs). An increase in the demand for their services and the challenges they already face make them prone to mental health illness. Therefore, there is a need to fur...

Background To reduce the spread of COVID-19, several countries in Africa instituted countrywide lockdowns and other public health measures. Whereas lockdowns contributed to the control of the pandemic, there were concerns about the unintended consequences of these measures especially in the most vulnerable populations. We assessed unintended socio-...

Background: Community health worker (CHW) programs in Uganda have contributed to improved health outcomes in recent years. However, opportunities for engaging the various stakeholders supporting CHW programs have been limited. This article presents workshop findings where several stakeholders shared their lessons and experiences that can enhance p...

Introduction Water should comply with standard/regulatory physio-chemical and biological parameters to ensure that it is safe for domestic use. We therefore sought to assess the physico-chemical and biological quality of groundwater sources in Kadama subcounty, Kibuku district, Eastern Uganda. Methods A cross-sectional quantitative study was conduc...

Introduction Water should comply with standard/regulatory physio-chemical and biological parameters to ensure that it is safe for domestic use. We therefore sought to assess the physico-chemical and biological quality of groundwater sources in Kadama subcounty, Kibuku district, Eastern Uganda. Methods A cross-sectional quantitative study was conduc...

Background: Timely health care among children with suspected malaria, and intermittent preventive treatment (IPTp) in pregnancy avert related morbidity and mortality in endemic regions especially in sub-Saharan Africa. Malaria burden has steadily been declining in endemic countries due to progress made in scaling up of such important interventions...

Background: Stigma continues to be a major barrier to tuberculosis (TB) control particularly in urban populations. Stigma can influence health seeking behaviour and affect adherence to TB treatment, yet few studies have examined TB related stigma and associated factors in Uganda. This study was therefore conducted to determine the level of stigma...

Antimicrobial resistance (AMR) is increasingly becoming a threat to global public health, not least in low- and middle-income countries (LMICs) where it is contributing to longer treatment for illnesses, use of higher generation drugs, more expenditure on antimicrobials, and increased deaths attributed to what should be treatable diseases. Some of...

Background Community health worker (CHW) programmes are again receiving more attention in global health, as reflected in important recent WHO guidance. However, there is a risk that current CHW programme efforts may result in disappointing performance if those promoting and delivering them fail to learn from past efforts. This is the first of a ser...

Background: This is the concluding paper of our 11-paper supplement, "Community health workers at the dawn of a new era". Methods: We relied on our collective experience, an extensive body of literature about community health workers (CHWs), and the other papers in this supplement to identify the most pressing challenges facing CHW programmes an...

Background While the evidence supporting the effectiveness of community health worker (CHW) programmes is substantial, there is also considerable evidence that many of these programmes have notable weaknesses that need to be addressed in order for them to reach their full potential. Thus, considerations about CHW programme performance and its asses...

Background Supervision is essential for optimizing performance and motivation of community health workers (CHWs). This paper, the seventh in our series, “Community health workers at the dawn of a new era”, supplements the existing evidence on CHW supervision in low- and middle-income countries by reviewing what supervision approaches are employed i...

Background To reduce the spread of COVID-19, several countries in Africa instituted countrywide lockdowns and other public health measures. Whereas lockdowns contributed to the control of the pandemic, there were concerns about the unintended consequences of these measures especially in the most vulnerable populations. We assessed unintended socio-...

Background: Despite Uganda and other sub-Saharan African countries missing their maternal mortality ratio (MMR) targets for Millennium Development Goal (MDG) 5, limited attention has been paid to policy design in the literature examining the persistence of preventable maternal mortality. This study examined the specific policy interventions design...

Background Social inclusion establishes a basis for the overall wellbeing of children with special needs. Although children’s lives are centred around the household, little is known about the household’s influence on social inclusion. Therefore, the aim is to investigate the household’s role in the social inclusion of children with special needs in...

Background Inappropriate use of antimicrobials in both humans and animals is a key driver of antimicrobial resistance (AMR). In addition, human behaviours such as poor disposal of antimicrobials in the environment can increase their exposure to microbes which can impact on humans and animals. However, evidence on access, use and disposal of antimic...

Solicited and Unsolicited Proposals: Determining Eligibility Ministry of Health / Makerere University School of Public Health, Public Health Fellowship Program, Grant Writing Course

Background A randomised controlled trial (RCT) on integrated malaria prevention, which advocates the use of several malaria prevention methods holistically, has been proposed. However, before conducting an RCT, it is recommended that a feasibility study is carried out to provide information to support the main study, particularly for such a complex...

Introduction: Pneumonia is a leading cause of death among children under five years of age in Uganda. Community Health Workers (CHWs) can prevent pneumonia deaths if they know how to manage the disease correctly. We conducted a study to determine factors associated with management of pneumonia among under-five year children by CHWs in Abim district...

Background: Initiating antenatal care within the first trimester and making at least four visits during pregnancy are recommended to enable screening and support for healthy lifestyles, well-being, and self-care in pregnancy. Due to glaring evidence on inequalities in access to antenatal care, this study assessed the effect of engaging community he...

Community health workers (CHWs) are a key human resource for health, particularly in low and middle-income countries. Participatory training approaches for CHWs are increasingly important as they actively engage participants, facilitate shared learning, and are more responsive to the needs of the learners. In addition, participatory training method...

Purpose This study aims to explore how cultural beliefs and traditions are integral to understanding indigenous mental health conditions (MHCs) and traditional healing (TH). However, Nigerian cultural beliefs about MHCs and TH are under-researched. Design/methodology/approach This study adopted a qualitative design using critical realist and socia...

Objectives: To synthesize evidence on the effectiveness of community-based interventions for cardiovascular disease (CVD) prevention in low- and middle-income countries (LMICs) to inform design of effective strategies for CVD prevention. Methods: We searched MEDLINE, EMBASE, CINAHL, Cochrane register of controlled studies and PSYCINFO databases for...

Africa is at a critical time undergoing demographic, epidemiological, political and socio-eco-nomic transitions and faced with repeated outbreaks of emerging and remerging diseases. The continent also faces other broader challenges of climate change, environmental degradation and pollution testing the resilience of its health systems and hindering...

Background: Although proper management of electronic waste (e-waste) is key to preventing disease and protecting the environment, there is no clear mechanism for its management in Uganda. This study assessed knowledge, perceptions, and practices of e-waste management among consumers in Kampala city, Uganda. Methods: We conducted a cross-sectiona...

Background Community health workers (CHWs) are an important cadre of the global health workforce as they are involved in providing health services at the community level. However, evidence on the role of CHWs in delivering interventions for non-communicable diseases (NCDs) in Uganda is limited. This study, therefore, assessed the involvement of CHW...

Background Consistent use of insecticide-treated nets (ITNs) and intermittent preventive treatment in pregnancy (IPTp) have been recommended as cost-effective interventions for malaria prevention during pregnancy in endemic areas. However, the coverage and utilization of these interventions during pregnancy in sub-Saharan Africa is still suboptimal...

Due to increasing urbanization, many people find themselves living in slums that expose them to several health risks. We explored urban health risks that fall short of the planetary boundaries in an urban slum in Kampala, Uganda using photovoice. We selected, trained, and assigned ten youth (five females and five males) to take photos on urban heal...

Despite youth constituting a large portion of the population in Uganda, their involvement in improving maternal health in their communities has been minimal. This paper explores the potential role of youth in contributing to maternal health in rural communities in Wakiso district, Uganda using photovoice. Photovoice was used as a community-based pa...

Face-masking could reduce the risk of COVID-19 transmission. We assessed knowledge, attitudes, perceptions, and practices toward COVID-19 and face-mask use among 644 high-risk individuals in Kampala, Uganda. In data analysis, descriptive, bivariate, and multivariate logistic regression analyses with a 95% CI were considered. Adjusted odds ratios we...